Office-Based Surgery Sites Not Entitled to Collect Facility Fees

In March of last year, Government Employees Insurance Co. filed an appeal to a lower court’s decision that Avanguard Medical Group, which operated an in-office surgical site, was permitted to charge the insurance company facility fees.  The New York appeals court, which heard the arguments, agreed with the plaintiff. According to the recently filed court decision, only hospitals and ASCs are permitted to collect these fees.

Outpatient Surgery Magazine reported on this decision stating that, “Office based surgery sites are governed by a different set of provisions than hospitals and ASCs, and those separate provisions don’t specifically provide for office-based practices to bill for such fees.”

The reasoning behind this decision is that hospitals and ASCs are required to meet an extensive list of requirements in terms of establishment, licensing and operations that office-based surgery sites are not.  The cost of maintaining compliance with these requirements justifies the facility fees. In order for office-based surgical sites to collect these fees, they will need to also adhere to the same requirements, and this would come at a high cost to them.

You can learn more by reading the full article at Outpatient Surgery Magazine.